Centro de Investigaciones en Bioquímica Clínica e Inmunología (CIBICI), CONICET, Córdoba, Argentina.
Departamento de Bioquímica Clínica, Facultad de Ciencias Químicas, Universidad Nacional de Córdoba, Córdoba, Argentina.
Front Public Health. 2023 May 9;11:1129166. doi: 10.3389/fpubh.2023.1129166. eCollection 2023.
is an obligate intracellular pathogen and the leading bacterial cause of sexually transmitted infections worldwide. genovars L1-L3 are responsible for lymphogranuloma venereum (LGV), an invasive sexually transmitted disease endemic in tropical and subtropical regions of Africa, South America, the Caribbean, India and South East Asia. The typical signs and symptoms of LGV urogenital infections in men include herpetiform ulcers, inguinal buboes, and/or lymphadenopathies. Since 2003, endemic cases of proctitis and proctocolitis caused by LGV emerged in Europe, mainly in HIV-positive men who have sex with men (MSM). Scarce data have been reported about unusual clinical presentations of LGV urogenital infections. Herein, we report a case of a 36-year-old heterosexual, HIV-negative male declaring he did not have sex with men or trans women, who presented to the Urology and Andrology outpatient clinic of a healthcare center from Cordoba, Argentina, with intermittent testicular pain over the preceding 6 months. Doppler ultrasound indicated right epididymitis and funiculitis. Out of 17 sexually transmitted infections (STIs) investigated, a positive result was obtained only for . Also, semen analysis revealed oligoasthenozoospermia, reduced sperm viability as well as increased sperm DNA fragmentation and necrosis, together with augmented reactive oxygen species (ROS) levels and the presence of anti-sperm IgG autoantibodies. In this context, doxycycline 100 mg/12 h for 45 days was prescribed. A post-treatment control documented microbiological cure along with resolution of clinical signs and symptoms and improved semen quality. Strikingly, sequencing of the gene revealed LGV L2 as the causative uropathogen. Remarkably, the patient did not present the typical signs and symptoms of LGV. Instead, the infection associated with chronic testicular pain, semen inflammation and markedly reduced sperm quality. To our knowledge, this is the first reported evidence of chronic epididymitis due to LGV L2 infection in an HIV-negative heterosexual man. These findings constitute important and valuable information for researchers and practitioners and highlight that LGV-L2 should be considered as putative etiologic agent of chronic epididymitis, even in the absence of the typical LGV signs and symptoms.
是一种专性细胞内病原体，也是全球性传播感染的主要细菌性病因。L1-L3 基因变种负责引起淋菌性腹股沟肉芽肿（LGV），这是一种侵袭性性传播疾病，流行于非洲、南美洲、加勒比海、印度和东南亚的热带和亚热带地区。男性 LGV 泌尿生殖道感染的典型体征和症状包括疱疹样溃疡、腹股沟脓肿和/或淋巴结病。自 2003 年以来，LGV 引起的直肠炎和直肠结肠炎在欧洲出现了地方性病例，主要发生在与男性发生性关系的艾滋病毒阳性男性（MSM）中。关于 LGV 泌尿生殖道感染不常见临床表现的报道很少。在此，我们报告了一例 36 岁的异性恋、艾滋病毒阴性男性病例，他声称自己没有与男性或跨性别女性发生性行为，他因过去 6 个月间歇性睾丸疼痛到阿根廷科尔多瓦的一家医疗中心泌尿科和男科门诊就诊。多普勒超声显示右侧附睾和精索炎。在 17 种性传播感染（STI）的检测中，只有 呈阳性结果。此外，精液分析显示少精弱精症，精子活力降低，精子 DNA 碎片化和坏死增加，同时活性氧（ROS）水平升高，存在抗精子 IgG 自身抗体。在这种情况下，给予多西环素 100mg/12h，疗程 45 天。治疗后控制证实了微生物学治愈，同时临床症状和体征得到缓解，精液质量得到改善。值得注意的是， 基因测序显示 LGV L2 为致病病原体。值得注意的是，该患者没有出现 LGV 的典型症状和体征。相反，感染与慢性睾丸疼痛、精液炎症和精子质量明显降低有关。据我们所知，这是首例报告的 HIV 阴性异性恋男性由 LGV L2 感染引起的慢性附睾炎的证据。这些发现为研究人员和临床医生提供了重要和有价值的信息，并强调即使没有典型的 LGV 体征和症状，LGV-L2 也应被视为慢性附睾炎的潜在病因。
